Yankov Yanko G, Nenova-Nogalcheva Anna K, Dimanov Simeon N, Stoev Lyuben L, Konstantinova Desislava A
Department of General and Operative Surgery, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR.
Department of Oral Surgery, Medical University of Varna, Varna, BGR.
Cureus. 2023 Sep 11;15(9):e45050. doi: 10.7759/cureus.45050. eCollection 2023 Sep.
We present a rare clinical case of a 64-year-old patient with a pigmented lesion localized in the left buccal mucosa. Subjective complaints of slight pain and discomfort in the process of eating and increased sensitivity when consuming hot food were reported. According to the information provided by the patient, the lesion had progressively increased in size. A history of previous dental manipulations was reported, namely, the extraction of teeth with amalgam obturations in the left half of the maxilla as per relevant indications. During the intraoral examination, a flat, black-colored lesion, 0.4 cm in diameter, with well-defined borders was observed in the buccal mucosa. Teeth 25, 26, and 27 were previously extracted five to seven years ago. An orthopantomography was performed as a routine procedure. It did not show any presence of X-ray contrast areas that could explain the symptoms of the patient. The symptomatic nature of the lesion as well as the negative radiological findings prompted surgical treatment and excisional biopsy with subsequent histological evaluation to rule out oral malignancy. An excision was performed. During the follow-up examination in the next eight days, all the symptoms of the patient were gone. The conclusion of the pathology report was "histological findings and clinical data consistent with amalgam tattoo". The amalgam tattoo is the most frequent iatrogenic pigmented lesion of the oral mucosa, which results from the implantation of amalgam particles in the soft tissues and it is usually asymptomatic. In this case, no surgical treatment is needed. However, in some rare cases, like the one we are presenting, some symptoms can occur and complicate the diagnostic process. In these cases, the complete excision of the lesion is to be performed with subsequent histological evaluation. The atraumatic intervention of teeth, obturated with definitive amalgam fillings, is a main factor for preventing this kind of pigmentation of the oral mucosa.
我们报告一例罕见的临床病例，患者为一名64岁男性，其左侧颊黏膜出现色素沉着病变。患者自述进食时略有疼痛和不适，食用热食时敏感性增加。根据患者提供的信息，病变大小逐渐增大。患者有既往牙科治疗史，即根据相关指征拔除了上颌左侧有汞合金充填物的牙齿。口腔检查时，在颊黏膜处观察到一个直径0.4 cm的扁平黑色病变，边界清晰。25、26和27号牙已于五至七年前拔除。作为常规检查进行了曲面断层摄影。未发现任何X线造影区域可解释患者的症状。病变的症状性质以及放射学检查结果阴性促使进行手术治疗和切除活检，随后进行组织学评估以排除口腔恶性肿瘤。进行了切除手术。在接下来八天的随访检查中，患者所有症状消失。病理报告结论为“组织学检查结果与临床资料符合汞合金纹身”。汞合金纹身是口腔黏膜最常见的医源性色素沉着病变，由汞合金颗粒植入软组织引起，通常无症状。在这种情况下，无需手术治疗。然而，在一些罕见病例中，如我们所呈现的这个病例，可能会出现一些症状并使诊断过程复杂化。在这些情况下，应进行病变的完整切除并随后进行组织学评估。对用确定性汞合金充填物充填的牙齿进行无创操作是预防这种口腔黏膜色素沉着的主要因素。
